Question 1: A patient is 4 hours post-lobectomy with a chest tube in place. Which
finding requires immediate intervention?
A. Chest tube drainage of 150 mL/hr
B. Serosanguineous drainage of 50 mL/hr
C. Tidaling in the water seal chamber
D. Mild incisional pain
CORRECT ANSWER: A. Chest tube drainage of 150 mL/hr
Rationale: Chest tube drainage exceeding 100–200 mL/hr suggests hemorrhage and
may require re-exploration. Serosanguineous drainage of 50 mL/hr is expected. Tidaling
is a normal finding. Mild incisional pain is expected postoperatively.
Question 2: A patient is 6 hours post-pneumonectomy. Which position is
contraindicated?
A. Supine
B. Semi-Fowler's
C. Turning onto the operative side
D. Turning onto the non-operative side
CORRECT ANSWER: C. Turning onto the operative side
Rationale: After pneumonectomy, turning onto the operative side is contraindicated
because the empty thoracic space can allow mediastinal shift and compression of the
remaining lung. Patients are typically positioned supine or with the operative side
elevated.
Question 3: A patient with a chest tube after thoracotomy has continuous bubbling
in the water seal chamber. What does this indicate?
A. Normal finding
B. Air leak
C. Tube obstruction
D. Resolution of pneumothorax
CORRECT ANSWER: B. Air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
nurse should assess the tube connections, dressing, and insertion site. Intermittent
bubbling may be normal with coughing.
,Question 4: A patient is 24 hours post-esophagectomy. Which finding is most
concerning?
A. Chest tube drainage of 100 mL/hr
B. Temperature 37.8°C
C. Heart rate 100 bpm
D. Pain rating 5/10
CORRECT ANSWER: A. Chest tube drainage of 100 mL/hr
Rationale: Chest tube drainage >100 mL/hr after esophagectomy may indicate
hemorrhage or anastomotic leak. This requires immediate provider notification. Mild
fever and tachycardia are expected postoperative findings.
Question 5: A patient with a chest tube develops sudden respiratory distress and
absent breath sounds on the a ected side. What is the priority nursing action?
A. Clamp the chest tube
B. Assess for tension pneumothorax and notify the provider
C. Increase oxygen
D. Document the finding
CORRECT ANSWER: B. Assess for tension pneumothorax and notify the provider
Rationale: Sudden respiratory distress with absent breath sounds suggests tension
pneumothorax. Immediate provider notification and possible needle decompression
are required. Clamping the chest tube would worsen the condition.
Question 6: A patient is 2 days post-thoracotomy and develops a fever of 38.9°C
with purulent sputum. What complication should the nurse suspect?
A. Atelectasis
B. Pneumonia
C. Pulmonary embolism
D. Wound infection
CORRECT ANSWER: B. Pneumonia
Rationale: Fever with purulent sputum after thoracotomy suggests pneumonia.
Atelectasis typically presents with low-grade fever and decreased breath sounds.
Pulmonary embolism presents with sudden dyspnea and chest pain.
,Question 7: A patient with a chest tube after lung resection has sudden cessation
of drainage with increased respiratory distress. What is the priority nursing action?
A. Strip the chest tube
B. Assess for tube obstruction or kinking and notify the provider
C. Clamp the chest tube
D. Increase suction pressure
CORRECT ANSWER: B. Assess for tube obstruction or kinking and notify the
provider
Rationale: Sudden cessation of drainage with respiratory distress may indicate tube
obstruction, kinking, or tension pneumothorax. Immediate assessment and provider
notification are required. Clamping would worsen the condition.
Question 8: A patient is 1 day post-pneumonectomy. Which finding indicates a
need for immediate intervention?
A. Tracheal deviation toward the operative side
B. Heart rate 90 bpm
C. Blood pressure 120/80 mmHg
D. Urine output 50 mL/hr
CORRECT ANSWER: A. Tracheal deviation toward the operative side
Rationale: Tracheal deviation toward the operative side after pneumonectomy may
indicate mediastinal shift, which can compromise the remaining lung and cardiac
function. Immediate provider notification is required.
Question 9: A patient with a chest tube is being ambulated. Which action is
appropriate?
A. Clamp the chest tube during ambulation
B. Keep the drainage system below the level of the chest
C. Disconnect the chest tube from suction
D. Elevate the drainage system above the chest
CORRECT ANSWER: B. Keep the drainage system below the level of the chest
Rationale: Keeping the drainage system below chest level prevents backflow of fluid
into the pleural space. Clamping the tube can cause tension pneumothorax.
Disconnecting from suction may be necessary but requires provider orders.
, Question 10: A patient is 3 days post-esophagectomy and develops a fever,
tachycardia, and chest pain. What complication should the nurse suspect?
A. Anastomotic leak
B. Atelectasis
C. Pneumonia
D. Pulmonary embolism
CORRECT ANSWER: A. Anastomotic leak
Rationale: Fever, tachycardia, and chest pain after esophagectomy are classic for
anastomotic leak. This is a surgical emergency requiring immediate provider
notification and possible re-exploration.
Question 11: A patient with a chest tube has subcutaneous emphysema around the
insertion site. What does this indicate?
A. Normal finding
B. Air leak into subcutaneous tissue
C. Tube obstruction
D. Infection
CORRECT ANSWER: B. Air leak into subcutaneous tissue
Rationale: Subcutaneous emphysema indicates air leaking into the subcutaneous
tissue, often from a loose dressing or tube site. The nurse should assess the tube and
dressing, and notify the provider if it worsens.
Question 12: A patient is 12 hours post-thoracotomy and develops a sudden onset
of dyspnea and pleuritic chest pain. What complication should the nurse suspect
first?
A. Pulmonary embolism
B. Atelectasis
C. Pneumonia
D. Pneumothorax
CORRECT ANSWER: A. Pulmonary embolism
Rationale: Sudden dyspnea and pleuritic chest pain after thoracotomy suggest
pulmonary embolism. Risk factors include immobility and surgery. Immediate
diagnostic imaging and anticoagulation are required.
finding requires immediate intervention?
A. Chest tube drainage of 150 mL/hr
B. Serosanguineous drainage of 50 mL/hr
C. Tidaling in the water seal chamber
D. Mild incisional pain
CORRECT ANSWER: A. Chest tube drainage of 150 mL/hr
Rationale: Chest tube drainage exceeding 100–200 mL/hr suggests hemorrhage and
may require re-exploration. Serosanguineous drainage of 50 mL/hr is expected. Tidaling
is a normal finding. Mild incisional pain is expected postoperatively.
Question 2: A patient is 6 hours post-pneumonectomy. Which position is
contraindicated?
A. Supine
B. Semi-Fowler's
C. Turning onto the operative side
D. Turning onto the non-operative side
CORRECT ANSWER: C. Turning onto the operative side
Rationale: After pneumonectomy, turning onto the operative side is contraindicated
because the empty thoracic space can allow mediastinal shift and compression of the
remaining lung. Patients are typically positioned supine or with the operative side
elevated.
Question 3: A patient with a chest tube after thoracotomy has continuous bubbling
in the water seal chamber. What does this indicate?
A. Normal finding
B. Air leak
C. Tube obstruction
D. Resolution of pneumothorax
CORRECT ANSWER: B. Air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
nurse should assess the tube connections, dressing, and insertion site. Intermittent
bubbling may be normal with coughing.
,Question 4: A patient is 24 hours post-esophagectomy. Which finding is most
concerning?
A. Chest tube drainage of 100 mL/hr
B. Temperature 37.8°C
C. Heart rate 100 bpm
D. Pain rating 5/10
CORRECT ANSWER: A. Chest tube drainage of 100 mL/hr
Rationale: Chest tube drainage >100 mL/hr after esophagectomy may indicate
hemorrhage or anastomotic leak. This requires immediate provider notification. Mild
fever and tachycardia are expected postoperative findings.
Question 5: A patient with a chest tube develops sudden respiratory distress and
absent breath sounds on the a ected side. What is the priority nursing action?
A. Clamp the chest tube
B. Assess for tension pneumothorax and notify the provider
C. Increase oxygen
D. Document the finding
CORRECT ANSWER: B. Assess for tension pneumothorax and notify the provider
Rationale: Sudden respiratory distress with absent breath sounds suggests tension
pneumothorax. Immediate provider notification and possible needle decompression
are required. Clamping the chest tube would worsen the condition.
Question 6: A patient is 2 days post-thoracotomy and develops a fever of 38.9°C
with purulent sputum. What complication should the nurse suspect?
A. Atelectasis
B. Pneumonia
C. Pulmonary embolism
D. Wound infection
CORRECT ANSWER: B. Pneumonia
Rationale: Fever with purulent sputum after thoracotomy suggests pneumonia.
Atelectasis typically presents with low-grade fever and decreased breath sounds.
Pulmonary embolism presents with sudden dyspnea and chest pain.
,Question 7: A patient with a chest tube after lung resection has sudden cessation
of drainage with increased respiratory distress. What is the priority nursing action?
A. Strip the chest tube
B. Assess for tube obstruction or kinking and notify the provider
C. Clamp the chest tube
D. Increase suction pressure
CORRECT ANSWER: B. Assess for tube obstruction or kinking and notify the
provider
Rationale: Sudden cessation of drainage with respiratory distress may indicate tube
obstruction, kinking, or tension pneumothorax. Immediate assessment and provider
notification are required. Clamping would worsen the condition.
Question 8: A patient is 1 day post-pneumonectomy. Which finding indicates a
need for immediate intervention?
A. Tracheal deviation toward the operative side
B. Heart rate 90 bpm
C. Blood pressure 120/80 mmHg
D. Urine output 50 mL/hr
CORRECT ANSWER: A. Tracheal deviation toward the operative side
Rationale: Tracheal deviation toward the operative side after pneumonectomy may
indicate mediastinal shift, which can compromise the remaining lung and cardiac
function. Immediate provider notification is required.
Question 9: A patient with a chest tube is being ambulated. Which action is
appropriate?
A. Clamp the chest tube during ambulation
B. Keep the drainage system below the level of the chest
C. Disconnect the chest tube from suction
D. Elevate the drainage system above the chest
CORRECT ANSWER: B. Keep the drainage system below the level of the chest
Rationale: Keeping the drainage system below chest level prevents backflow of fluid
into the pleural space. Clamping the tube can cause tension pneumothorax.
Disconnecting from suction may be necessary but requires provider orders.
, Question 10: A patient is 3 days post-esophagectomy and develops a fever,
tachycardia, and chest pain. What complication should the nurse suspect?
A. Anastomotic leak
B. Atelectasis
C. Pneumonia
D. Pulmonary embolism
CORRECT ANSWER: A. Anastomotic leak
Rationale: Fever, tachycardia, and chest pain after esophagectomy are classic for
anastomotic leak. This is a surgical emergency requiring immediate provider
notification and possible re-exploration.
Question 11: A patient with a chest tube has subcutaneous emphysema around the
insertion site. What does this indicate?
A. Normal finding
B. Air leak into subcutaneous tissue
C. Tube obstruction
D. Infection
CORRECT ANSWER: B. Air leak into subcutaneous tissue
Rationale: Subcutaneous emphysema indicates air leaking into the subcutaneous
tissue, often from a loose dressing or tube site. The nurse should assess the tube and
dressing, and notify the provider if it worsens.
Question 12: A patient is 12 hours post-thoracotomy and develops a sudden onset
of dyspnea and pleuritic chest pain. What complication should the nurse suspect
first?
A. Pulmonary embolism
B. Atelectasis
C. Pneumonia
D. Pneumothorax
CORRECT ANSWER: A. Pulmonary embolism
Rationale: Sudden dyspnea and pleuritic chest pain after thoracotomy suggest
pulmonary embolism. Risk factors include immobility and surgery. Immediate
diagnostic imaging and anticoagulation are required.
